North Devon Hospice Quality Account 2016-2017

Quality Account 2016/2017 www.northdevonhospice.org.uk

4 Our achievements 6 Overview of Clinical Governance 7 A look at our patient services 14 Priorities for 2017/2018 14 Statements of Quality Assurances 16 How to refer to our services Dear Colleagues, Although we have made significant leaps forward in early referral cases, we continue to rely heavily on you, our healthcare partners, to refer your patients and their families to us as early as possible in their diagnosis. This is vital in ensuring we can be there for the entirety of their journey.

For the forthcoming year, we remain absolutely committed to providing more care and support within people’s own homes. Early referrals are key to ensure local patients and their families can access as much of our care as possible and we will work closely with care providers to make this happen.

We very much look forward to working with you over the next 12 months and into the future.

Warm regards,

Rachel McCarty Director of Care, Registered Manager & Accountable Officer for Controlled Drugs

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Murray Fletcher Medical Director and Consultant in Palliative Medicine

About North Devon Hospice North Devon Hospice is a local charity providing specialist care to over 2,000 patients and their families each year who are facing a life-limiting illness from across North Devon.

Although many of our patients have cancer, we also care for people who have other life-limiting illnesses including motor neurone disease, heart and liver failure and COPD. We provide a hospice to home service, inpatient care in our bedded unit, a team of clinical nurse specialists and a supportive care service that includes bereavement support. Most of the care we provide is delivered out in the community right across North Devon, covering 800 square miles, at no cost to our patients and their families by a highly skilled team of specialists.

We need to raise over ÂŁ4.5 million every year in charitable income to keep providing our care and completely rely on the generous support of the local community to help raise this.

To refer your patients to our services call 01271 344248.

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Our Achievements

2,000 800 200 80 4.5 million the number of people we cared for last year

the number of square miles we cover across North Devon

the number of patients we have been able to support since opening The Long House in Holsworthy

pence in each pound raised is spent directly on patient care

the amount we need to raise each year

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260 142 4,526 572 80%

the number of hospital admissions avoided last year

the number of admissions into our bedded unit last year

the number of visits our Community Nurse Specialist team made to patients last year

the number of healthcare professionals attending end of life training last year

of patients achieved their preferred place of care

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Overview of Clinical Governance We pride ourselves on providing people-focused care of the highest standard. We monitor our efficiency and effectiveness through quality control audits: Clinical Audits - ‘I want great care’ - Patient and carers focus group review - Carers support needs assessment tool - Controlled drugs - Medicine management - Hand hygiene - Infection control clinical care environment - Preferred priorities for care documentation - Single point of access - Document scanning - Nutritional clinical supervision - Management of terminal agitation - Effectiveness of Hyoscine in reducing secretions in terminally ill patients - Safe disposal of sharps - South West Hospices informatics project: medication errors, falls and pressure damage - South West Hospices regional preferred place of care for the dying

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- Help the Hospices - National medication errors, falls and pressure damage

Learning Points - Management of complex pain - Opioid switching - Use of co-analgesics - GI obstruction - Prescribing in renal failure - Management of nausea and vomiting - Ethical challenges of nutrition and hydration - Clinical decision making avoiding errors - Aromatherapy in palliative care

Significant Event Meeting - Care and support of patients talking of suicide - Challenges of severe breathlessness - Discharge review

Clinical Nurse Specialists SOME OF OUR ACHIEVEMENTS FROM LAST YEAR

Visits made by our CNS team = 4,526 Patients receiving contact from our CNS team, in person or on the phone = 7,196 Miles covered by our CNS last year = 52,441 Our team of nurses provide specialist care, advice and emotional support to patients and their families in the care setting of their choice. They will also focus on helping to improve quality of life for those people facing a life-limiting illness. From the comfort of their homes, families can share how they’re feeling and get support and advice on how to manage symptoms and deal with any additional queries or worries that they are experiencing and help to plan for the future.

Our nursing team not only offer home visits and advice about a patients illness but will also be able to provide information about other services that may be beneficial. With a family’s permission, our nurses will be able to work closely with a patients own GP, District Nurse and other health care professionals to ensure that the best, joined up care is available. Telephone advice is available from the CNS team as required.

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Hospice to Home is absolutely amazing.

Because to start with it was just us, trying to battle our way through something we knew nothing about. It’s quite incredible I think. We’d be lost without them.

Bedded Unit SOME OF OUR ACHIEVEMENTS FROM LAST YEAR

Total patients cared for on our Bedded Unit = 127 Average length of stay = 10 days We support our patients with symptom control and end of life care on our 7 bedded unit. We always aim to go the extra mile to give our patients the care and support they need, making them comfortable during their final weeks and days of life.

Our nurse to patient ratio allows us the opportunity to give dedicated support to patients with a variety of symptoms associated with a life-limiting illness. We meet people at a difficult time in their lives and the support given by our nurses and healthcare assistants continue to provide comfort to those they meet. In keeping with fulfilling patient’s preferred place of care, around 60% of patients are discharged after a short stay with us.

Hospice to Home SOME OF OUR ACHIEVEMENTS FROM LAST YEAR

Total referrals to our Hospice to Home team = 329 Hours spent with patients at home = 6,406 Our team look after patients and their carers who prefer to receive help at home. We offer a rapid response service and can provide round the clock care. We support our patients with symptom control, psychological support, personal care and practical help. We are specifically here for patients and their families who need more hands-on care and support towards the end of life.

Our healthcare support workers offer respite sits at night in patient homes which can not only help to keep a patient from having to go back into hospital, but can give a family a valuable break.

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Somewhere in the sky there is a star that radiates a haven of serenity, kindness, dignity, love, caring, assurance and peace. On this earth there is a mirror image of that star, it is called ‘North Devon Hospice.’

Supportive Care SOME OF OUR ACHIEVEMENTS FROM LAST YEAR

Total patients and family members supported = 965 Bereavement support sessions given to family members = 1,572 We recognise that every person is unique and will have different needs. For this reason we provide a wide range of services and, together with the family, we can decide which of those would be of most benefit to them.

We’re currently offering one-to-one support (adults and children), complementary therapies, pastoral and spiritual care, a bereavement support group; food and film events for patients, carers and family members; a ‘time for you’ support session run by nursing staff; a patient support group; a carer support group plus wellbeing sessions including massage and hairdressing. We continually review and adapt our activities to tailor to individual needs, such as: - Seated exercise - Managing fatigue - Stress and anxiety courses - Talking to children about bereavement Our team can support: - adult patients who have a limited life expectancy and are in the palliative stage of their disease - colleagues/friends and relatives of that patient, including children - bereaved adults and children where the deceased had been a palliative care patient, either in North Devon or elsewhere

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Education SOME OF OUR ACHIEVEMENTS FROM LAST YEAR

Healthcare professionals trained in 2016/2017 = 572 Nursing/Residential home staff supported with training = 334 Our education team support our own clinical staff with training needs and also work with healthcare professionals, care home staff, GPs and healthcare students across North Devon helping to develop their skills and confidence in working with people facing life-limiting illnesses.

A snapshot of some of our courses available in the coming months: - Bereavement and Loss Study Day - Dementia and End of Life Care Study Day - Symptom Management at End of Life Study Day - Care of the Dying Study Day - Communication at End of Life Outreach Training - Care in the Last Days of Life Outreach Training - Bereavement and Loss Outreach Training - NCFE Level 3 Principles of End of Life Care Certificate - Six Steps Plus End of Life Programme

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I have learnt how to approach death as a part of life and make it a less scary and sad thing for patients and their families.

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Priorities for 2017/2018 - Achieve funding from the NHS for our Hospice to Home service - Enhance our partnership working with NDHT and Out of Hours team - Achieve an ‘Outstanding’ rating at our next CQC Inspection

Statements of Quality Assurances In compliance with statutory regulations, North Devon Hospice’s Board of Trustees can confirm: 1.1

During 2016-17 North Devon Hospice provided or sub-contracted no NHS services directly. A grant was received from the new Clinical Commissioning Group to provide palliative and end of life care.

1.2 During 2016-17, no National Clinical Audits and no National

Confidential Enquiries covered NHS services that North

Devon Hospice provides.

1.3 The reports of 18 clinical audits were reviewed by North

Devon Hospice in 2016-17 and North Devon Hospice will

take action to continue improving the quality of healthcare provided.

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1.4

The number of patients receiving NHS services provided or sub-contracted by North Devon Hospice in 2016-17 that were recruited during that period to participate in research approved by a research ethics committee was zero.

1.5 North Devon Hospice’s income in 2016-17 was not

conditional on achieving quality improvement and innovation

goals through the Care Quality Commission.

1.6 North Devon Hospice is required to register with the Care

Quality Commission and its current registration status is active.

We are active in the following areas:

- Treatment of disease, disorder and injury - Caring for adults under 65 years - Caring for adults over 65 years - Personal care

1.7 The Care Quality Commission has not taken enforcement

action against North Devon Hospice during the reporting

period of 2016-17.

1.8 North Devon Hospice has not participated in any special

reviews or investigations by the Care Quality Commission

during the reporting period.

1.9

North Devon Hospice did not submit recordings during 2016-17 to the Secondary Users Service for inclusion in the Hospital Episode Statistics which are included in the latest publication data.

1.10 North Devon Hospice was not subject to the Payment by

Results Clinical Coding Audit during 2016-17 by the Adult Commission.

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How to refer to our services Referring your patients and their family members to us early ensures that they are able to access a whole range of care and support services, at any point throughout their journey from initial diagnosis.

It can also help to negate the volume of support related visits to GPs. We respond to all clinical referrals within 24 hours and supportive care referrals within 5 working days.

Please call us on 01271 344248 to discuss your needs.

Clinical Nurse Specialist Service We provide a specialist palliative care community nursing service for adult patients who have a progressive illness or are on the Gold Standards Framework Register and would benefit from symptom management, psychological assistance and holistic care with emotional or spiritual needs. The multi-disciplinary team work closely with other healthcare providers to ensure the patient is supported on an individual basis, a 24 hour advice line is available with the CNS team for local professional colleagues to contact.

Each patient has a named contact within the team and we respond within 24 hours to case referrals.

Agreement for CNS intervention must be received from the patients’ GP on all occasions. Contact our team on the number above.

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The Bedded Unit We provide a specialist palliative care in-patient service for adults with complex problems associated with advanced progressive illnesses. This is available to patients who have complex end of life care needs and require treatment for pain management or other distressing symptoms 24 hours a day.

All requests for referral to our bedded unit must be with the explicit agreement of the GP and/or relevant hospital consultant. In urgent and out of hours cases, call the Duty Medical Officer on 01271 347214, alternatively contact the main hospice number on 01271 344248.

Hospice to Home Service We provide care and support for patients at or near end of life, as a short-term intervention, to help prevent a crisis from escalating or to avoid an acute admission. This service is available to patients who are identified as being in the last 3 months of life.

Referrals can be made between 8.30am – 5pm, Monday to Friday by calling 01271 347246/7, or out of hours by calling 01392 822342.

Referrals are accepted from all healthcare professionals.

Supportive Care Services We provide a range of supportive care services, pre and post bereavement to patients, carers and family members, including children.

These services are available to all patients within the care of the hospice along with any adults and children who are affected by the diagnosis or have been bereaved as a result of a patient’s death.

Referrals can be made by GPs, consultants, social services, other hospices and other agencies. Please contact us on 01271 344248 to discuss how we could help.

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Where we offer our services We have been providing care for over 30 years. The majority of our care is provided within peoples own homes. In addition to the care and support we offer throughout the community, we have teams based at two locations in North Devon.

Deer Park, Barnstaple Our main site is based on the outskirts of Barnstaple. Our patients and families can access a wide range of care and support services, including our 7 bedded in-patient unit.

North Devon Hospice, Deer Park, Barnstaple, North Devon EX32 0HU. Tel 01271 344248 The Long House, Holsworthy Thanks to fundraising throughout the community, we opened the doors to our second building in 2015. This purpose built outreach centre is adjacent to Holsworthy Medical Centre.

Patients and their families can access a range of supportive care services including group support, complementary therapies and one-to-one support.

North Devon Hospice, The Long House, Dobles Lane, Holsworthy, North Devon EX22 6GH. Tel 01271 344248

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Thank you We rely on support from our local community to be able to continue providing the level of care we currently offer for patients and their families. We need to raise over ÂŁ4.5m each year to be able to provide our care and support year on year. We can only do this thanks to regular donations, fundraising, events, donations to our charity shops and gifts left to us in wills.

On behalf of every patient and family member we have supported over the last year, we thank you for your continued support of North Devon Hospice.

If you have any comments or questions about the information provided within this publication, or on our services, we would love to hear from you. Please contact Rachel McCarty by post, email or telephone: Rachel McCarty Msc, BSc, RN Director of Care, Registered Manager & Accountable Officer for Controlled Drugs.

North Devon Hospice, Deer Park, Barnstaple, North Devon EX32 0HU 01271 347203 rachelmccarty@northdevonhospice.org.uk

Crosscare

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For us the hospice has been a constant throughout the whole process. Going through so much instability and uncertainty, knowing that we had this safe place where we could go was amazing.

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North Devon Hospice, Deer Park, Barnstaple, Devon EX32 0HU email: info@northdevonhospice.org.uk www.northdevonhospice.org.uk / 01271 344248 Registered charity number 286554.